This post is dedicated to my friends who work in the homecare department in the hospital I work at. I hope you enjoy!!
There are two main reasons why we get out and pound the pavements. One is marketing and the other is homecare. But first a little background.
|Pounding the pavement.... the view back over Kangwangware|
from the railway line... on our way to Ngong.... yes we walked
FreMo is basically a private hospital. It has the facility to provide most care including antenatal, birth (normal), postnatal and now, thanks to our fundraising, immunisation. The local public hospital just down the road provides antenatal care, but not birth. So when the women get to 36 weeks of pregnancy they are told to go find somewhere to deliver. That’s why we do marketing. We hang around town on the busy days handing out leaflets and inviting women to come and check us out. They come and birth without too much antenatal input from us, and their hand held records usually have the basic information required, and I mean basic. Once they have delivered, they might spend 12 hours or so in with us then we start what we call ‘outreach’, but you know it as homecare.
We do outreach every week day, and we usually see the mumma
and baby at home within the first 3 days. Then they are invited to come for a check-up
at the hospital and then we usually determine when we need to see them again.
If there are no problems, we continue to visit every fortnight for two months.
|Magdalene and myself at a home visit.|
Of course, I get to cuddle the babies...
But this IS Kendall whom I helped her mum with!
|Eunice Popped back in for a check up!|
|Mercy and Magdalene navigate a rather|
rickety bridge .... and then turn to check on me
and make sure that I make it over...
The postnatal check on the baby is extensive. At each baby check we weigh the baby, measure the heart rate, respiratory rate, temperature as well as the additional details that we know so well. We check the umbi and clean it with spirits and advise the mums to do the same. They don’t. Some mums prefer to use charcoal to dry it out. All the mothers have their blood pressure checked as well as the usual checks and balances. When we return to the hospital the information is transcribed into a postnatal register that the government keeps (we have one for antenatal as well as birth!!).
We don’t talk about SIDS and safe sleeping. We don’t talk about how to make up the cot linen for the baby to sleep safely. We don’t discourage co-sleeping and we don’t discuss overheating. Most all of the women live in corrugated iron shacks, one family to a room which is usually 3-4m square. Sometimes the walls are brick but the roof is still iron. A curtain will separate the sleeping section from the living section. There are always lace curtains. The sleeping section usually has one single bed for everyone, and the living section will have a sofa crammed in with everything else. The ‘kitchen’ is any accumulation of surfaces that might hold utensils with a cooker of some sort (gas, charcoal or electric) featured somewhere, usually on the floor. Food is not stored, it is bought every day. Babies sleep in the bed next to mumma with everyone else, and are usually wrapped in several layers. I counted 8 layers on one baby.
Breastfeeding rates are 100% and there is a new
definition to on demand… read all the time. Physiological jaundice hardly gets
a mention, and when it does, mums are encouraged to feed the baby outside
occasionally. There is usually only one window (and door) per room and they are
usually very dark.
|Mary at home with her twins. Her's is another whole story on it's|
own. Here you can see the sleeping side of her home.
|Kids filing our of school.... a photo because I liked it!|
Now here is the thing, girls. We walk. We walk all over the slums, everywhere, over drains and rubbish piles, past the pigs and goats shuffling through the rubbish looking for something to eat. We walk through the markets and through compounds taking short cuts. We walk sometimes for 4 hours with our equipment in packs on our backs. As we walk we constantly hear the work ‘Mzungu’. Yes that’s me. Crazy drunk men want to shake my hand, children want to touch me, and mothers just look as I pass by. Often I say ‘Habari’ and in return they chorus ‘Muzuri Sana’ – good thanks. We travel in three’s with Magdalene the midwife, myself (I get to do the baby checks and have nice cuddles too!!) and Mercy. We are known as 3M!!
Now what can I tell you about Mercy. She is one of the hard
workers here. Her job is multi pronged but titled ‘Midwifery Assistant’. She
does everything from feed the women, clean the floors, hang and fold washing
and put it away, wash the dishes, fetch and carry and most importantly, she is
our GPS. She knows these slums back to front and upside down. Considering there
are no real street addresses, she manages to find everyone. She phones and lets
the mothers know we are coming, and if it is difficult to find, she arranges to
meet a relative somewhere close by. She translates for me, laughs at my
attempts at Kiswahili, explains things as we go and best of all she documents
our findings for us. Sometimes she’ll even buy something in the markets on my
behalf if I don’t want to pay white woman’s prices!! And not because she asked me to, but I will leave Mercy my shoes when I leave, seriously, these shoes stand up to everything. That must be a recommendation to nurses and midwives everywhere!!!
|Rubbish and Dust!!|
|The dirty dusty hard working feet!|
|Could these shoes look any worse for wear???|
|The shoe shine boy in progress and|
below... after... good as new!!!
By the way, did I mention we walk? Everywhere? Seriously, If I don’t lose weight doing this there is something seriously wrong with me!